Hi Guys, I’ve been off my ADD meds for 3 years now (concerta)and am looking to start back up with them. Since I’ve been off my ADD meds, I’ve started on TRT.
Should I tell my psychiatrist that I am on TRT, do you anticipate there will be any problems? I’m sure that she’ll probably be able to see all of my prescriptions in some database somewhere. I know telling the doctor is the right thing to do but I just feel like explaining this to her will be difficult.
You didn’t do anything wrong, there’s no shame in being on hormone therapy.
Concerta can cause ED, maybe try Vyvanse, you might even experience increased libido.
I’m on 60mg of Vyvanse (Elvanse in UK) for (severe) ADHD and TRT (just started 5 weeks ago). (I tried weaning myself off ADHD meds using nootropics, it failed horribly!).
The only feedback I got from the psychiatrist is that TRT may allow for a lower Elvanse dose and currently testing 50mg (60mg is a lot!). The theory being is that the low motivation (which is made worse by scatter brain) is theoretically fixed via TRT. The balance between motivation and discipline then can be altered.
I agree with systemlord; try ask for Elvanse for your 2nd test. They act very differently:
Concerta (Ridalin in UK) has a higher peak, but a very rough trough. It’s more like a big hammer that swings inside your brain to flood it with dopamine and norephedrine. It’s also fast acting and used alot by drug addicts who crush it up. Tried it when I was in school, it was way WAY to much.
Elvanse also increases dopamine and norephedrine but it does it in a more subtle indirect way by blocking its reuptake. It also has to be metabolized, so it can’t be abused like Ritalin can. It has a very smooth on and off ramp. You don’t get the AAHHHH gotta do stuff vs AAHHHHH I’m completely lethargic effect.
I find that whilst Elvanse is active, getting excited via sexual stimulation is very difficult ie the bar is higher. But once stimulated, you can last a very long time. Once the effect begins wearing off, your stimulation bar reduces.
The active metabolite of lisdexamfetamine (vyvanse) is dextroamphetamine
I take dextroamphetamine. Not sure about the UK
But dextroamphetamine (not so much vyvanse) is a common street drug in Australia. Due to the way vyvanse is metabolised, you can’t insufflate, smoke or inject lisdexamphetamine.
Imo vyvanse is the better option if you can tolerate the side effects of stimulants.
Yes.
No.
Patients I see that are also under psychiatric care have found them to be supportive of HRT. On top of that, they are generally open to reducing medications if possible. I have met doctors from all kinds of specialties at medical conferences on hormones and, at least initially, was surprised at how many psychiatrists attend.
You might ask your doctor about the pros and cons of various medications, like mentioned here, and get her thoughts on why she likes a particular one for you, especially if she can help you understand the why behind her recommendation. I would follow your doctor’s advice though. Keep in mind she likely has experience treating thousands of patients with these drugs, vs one person who has taken a particular drug or simply read about it.
Good luck.
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i would not bother telling her
a) she probably doesn’t give a shit and/or doesn’t really know what to do with it and even if, what will she do???
btw, i tried vyvanse in the past and hated it. no way this shit won’t mess your sleep long term. it has a ‘double’ half life, one from the lis and one from the dex
i would prob go with pure dextroamphetamine tbh. and never take this daily
IMHO those are good stimulants but don’t do shit for so called ‘ADHD’ (which doesn’t exist really)
All the stimulant ADHD drugs can cause ED, lower libido, or both. Some people report higher libido on stimulants (and this isn’t specific to one type). It seems to me it is individual how someone will respond to them.
I take generic adderall IR and my libido goes down a bit. TBH, it is a good thing for me. I’ve had Vyvanse once and it lowered it as much as the adderall, except for much longer (since it lasts longer).
That doesn’t surprise me. It seems research points to stims and counseling as being by far the best treatments.
TRT didn’t help with ADHD for me. Did TRT first thinking my low T was the issue. It perhaps helps, but at least for me it is a tiny fraction of what adderall does regarding ADHD symptoms.
This is what I do if I have a test coming up
But I hate the appetite suppression… also gives me acid reflux.
Like you’ve said… vyvanse is a one way ticket to never sleeping.
My friends ex girlfriend has one of the worst cases of ADHD (dx in childhood) i’ve EVER seen
She takes a high dose of vyvanse and has severe, severe insomnia as a result.
My vyvanse dose was 20mg. My dex dose is 5-10mg when I take it
I’m supposed to take 5-20mg/day. I’ve been told daily use equates to better results. But if I took daily I’d never eat.
However I’m far more calm and collected when I’m on the low dose of stimulants (aside from exacerbation of underlying dysautonomia)
interesting. I am super hungry after dex. try some tobacco free nicotine pouches with it, stimulates appetite big time for me.
i highly doubt that daily use equates better results. this stuff doesn’t build up like lets say BP meds like telmisartan. I personally take it 3-4x a week max, at 2x5mg, and never past 12pm. I also don’t do caffeine on those days either, as it is somewhat counter-productive. daily use is a fast ticket to tolerance build up/dependance and subsequent withdrawal hell
IDK what is going on for you. Both of those things are fairly potent appetite suppressants for most people.
I’d also recommend not advising people to use nicotine pouches. Too addicting IMO to dabble with for many people.
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Huh?
You mean like nicotine gum?
I probably smoke a cigarette once a month or so :). Yes, nicotine does help alleviate burden associated with ADHD. All stimulants that have a pronounced impact on dopamine release tend to help adhd
Those with legitimate add/adhd have less dopamine at baseline. Dopamine isn’t just “pleasure/addiction”. Dopamine is also released in response to indulging in activities that facilitate survival, concentration, mood, sleep etc.
So eating, drinking, sleeping, task management… lack of baseline dopamine leads the individual to lack baseline levels of arousal required to concentrate on manual tasks, studying etc.
Not a mere “ahh im just lazy” but the brain incessantly switches from one topic to another as it is impossible to elicit an adequate level of baseline arousal when learning, sticking to one subject
Biggest symptom of dopamine deficiency is lacking focus/motivation (present from early childhood onwards). ADHD is overdiagnosed and therefore tends to be subject to scrutiny.
Around 2% of adults have ADHD. The effective treatment = boosting dopamine through medication (no… natural alternatives cannot restory faulty neurobiological makeup). Hence stimulants… as most stimulants reliably boost dopamine output.
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velo/zyn brands, every gas station has them.
where is the dopamine deficiency theory coming from? I am somewhat suspicious about this, if this is similar to the serotonin deficiency/SSRI’s which is total bunk.
by no means I say that concentration is not an issue for many, I have to issues with it. just not sure if its a pure dopamine problem. sure, amphetamines work, since you become hyper-focused, but the root cause is still there. it is just that those drugs overpower it
Agree.
I don’t know exactly who first proposed it. Russel Barkley (probably the most prominent expert on ADHD) has talked about it and the research quite a bit. I would think if you googled his name and dopamine, you could find an explanation.
Neurobiology of ADHD - PubMed (nih.gov)
Role of dopamine receptors in ADHD: a systematic meta-analysis - PubMed (nih.gov)
There are degrees to this
“trouble concentrating” isn’t ADD/ADHD
True ADD/ADHD is “literally cannot focus on more than one task, disorganised, impulsive (likely to engage in risky behaviour… might be a thrill seeker), lack of motivation (all the time), restlessness, problems maintaining relationships.”
If someone REALLY has untreated ADD/ADHD as an adult, chances are they’ll be… quite eccentric. It only REALLY seems to affect around 2% of adults.
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Which is likely also why depression is also very common in adults with ADHD. Treating depression I don’t think helps much in this case as the depression is a side effect of the ADHD. Treating the ADHD has helped me in this area.
It isn’t random though. Genetics is a factor. Having family members with autism or others with ADHD increases someones odds of having it.
The issue for ADD/ ADHD meds is the only way you are getting them is if you dont have high blood pressure. My Dr checks mine every visit. Gear raises my blood pressure and so does adderall. Very dangerous combo if not kept in check. Chances are if you tell the dr, you wont get your meds unfortunately. The best question is what would TRT dr say if they know you take vyvance or adderall.
Agreed
But this is a dose dependent effect with both T and stims
Can opt for modafinil, atomoxetine as a middle ground etc.
Otherwise ace inhibitors, ARB’s, beta blockers, calcium channel blockers… the list goes on
Hypertension is treatable
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That is a fact. Thanks for the options as i need them as we speak.
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Fwiw, I’ve used telmisartan and I can’t tell I’m on it (as far as negative side effects). Lowers BP pretty well for me. On blast, it can bring me from 135, to low 120s, and that’s with the lowest prescribed dose (20mg).
A side benefit is that it can lower water retention. I suppose the degree of that is individual, but I found it a nice bonus on blast.
I don’t really need it now. Leaned up, and started taking cardio more seriously. I’ll still probably use it on blast if my BP is even slightly elevated. I like the drying out effect too much haha.